Integrative strategy for Long COVID neuropsychiatric symptoms: A case report on Kamikihito and Bupleurum-Scutellaria formulas guided by pharmacological rationale

Brain fog is a refractory symptom of Long COVID lacking established standard treatments. We present a case of a male in his fifties who developed persistent brain fog, fatigue, and anxiety five months post-COVID-19. Baseline assessments revealed significant impairment in quality of life (The EuroQol 5 dimensions 5 levels [EQ-5D-5L]: health-related QOL [HR-QOL] 0.696, EQ-visual analogue scale [VAS]: 50, and 12-Item Short-Form Health Survey [SF-12] Mental Component Summary [MCS]: 38.5, Role/Social Component Summary .[RCS]: 34.6) and high psychological distress (the Self-rating Depression Scale [SDS]: 50, the State-Trait Anxiety Inventory [STAI]-state/trait: 60/49). We employed an integrative therapeutic strategy combining diagnosis based on Japanese traditional medicine (Kampo medicine) with modern pharmacological rationale. Initially, Kamikihito was prescribed to alleviate anxiety and support neurogenesis. Subsequently, considering the mechanism of neuroinflammation, Saireito and Saikokaryukotsuboreito-formulas containing Scutellaria root and Bupleurum root-may be added to suppress microglial activation. Following this regimen, symptoms were alleviated, enabling a return to work within 2.5 months. At three months, marked improvements were observed (EQ-5D-5L HR-QOL: 0.839, EQ-VAS: 70, and SF-12 MCS 46.7, RCS 41.8). This case suggests that an integrative approach simultaneously targeting neuroinflammation and neurogenesis offers a promising therapeutic option for Long COVID brain fog.